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Abstract: Clinical trial data and fracture risk prediction models unequivocally demonstrate the utility of identifying prevalent vertebral fractures to predict future fractures of all types. Knowledge of prevalent vertebral fractures can alter patient management decisions and result in initiation of therapy to reduce fracture risk in some patients who would not otherwise be treated. Cost-benefit analysis demonstrates that identifying and treating patients with vertebral fractures, even those with a densitometric classification of osteopenia, is cost effective. Vertebral fractures can be readily identified in the office setting using standard radiography or Vertebral Fracture Assessment (VFA), a software addition to a central dual-energy X-ray absorptiometry (DXA) machine. In the United States, VFA was assigned a Current Procedural Terminology (CPT) code in January 2005. Nevertheless, coverage of VFA has not been uniformly embraced by Medicare carriers, companies that contract with the federal government to administer Medicare coverage and process claims for a region of the United States. Unlike DXA, for which uniform national coverage of qualified Medicare beneficiaries is mandated by the Balanced Budget Act of 1997, VFA coverage policies are determined by the local Medicare carriers. Third-party insurers are also variable in their coverage of VFA. This International Society for Clinical Densitometry (ISCD) White Paper documents the role of VFA in the evaluation and treatment of women with postmenopausal osteoporosis and compares it with standard spine radiography. Arguments used by some Medicare carriers and insurers to deny coverage of VFA in the United States are analyzed and critiqued. For health care providers within the United States, this White Paper may serve as a resource to respond to insurers who deny coverage of VFA. For health care providers regardless of their country, this article underscores the value of VFA as an alternative to spine radiography in the evaluation and management of postmenopausal women with suspected osteoporosis. [Copyright &y& Elsevier]

What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

The article presents an overview of the ethics and morality of Medicaid planning in the U.S. Medicaid planning refers to the legal fiction of rearranging assets to make someone poor on paper so that he or she may qualify for Medicaid. Medicaid was initially developed by the U.S. Congress in 1965 during the presidency of former U.S. President Lyndon Baines Johnson and during an era of civil rights reforms. The reasons why Medicaid planning is undertaken often affect whether it is perceived as moral. For instance, as will be seen below, whether Medicaid planning is utilized to preserve an inheritance, to enhance an institutionalized person's quality of care, or to protect a community spouse from impoverishment can all affect judgments of morality.

The article discusses the position of the American Public Health Association on reduced prescription drug coverage because of increasing drug prices in the U.S. The association has called for the addition of a prescription drug benefit to the Medicare program, at the same time recognizing that drug pricing will be a major factor determining whether a Medicare drug benefit is practicable. Factors that contribute to high drug prices are the large profit margins cleared by the drug industry, advertising and marketing expenditures, and large international price disparities that buyers are subjected to.

This article presents the necessary role of public health and population-based programs for supporting and enhancing the effectiveness of a reformed health care insurance system in the U.S. Preventive measures focused on chronic and infectious diseases and injuries provide much of the substance of these programs, but there are also core public health functions that are necessary to support and sustain efforts that address the health needs and conditions of populations, as distinct from individuals. The importance of a population-based approach is illustrated by a report, cited in a 1982 study by the Institute of Medicine, which concluded that only 10 percent of premature deaths in the U.S. could have been avoided through improvements in access to medical treatment. For health care reform to succeed, the supporting and complementary functions of public health must be enhanced. If the amount used by State and local health agencies and the U.S. Public Health Service for public health functions had maintained their proportionate position to the treatment services they support, their 1993 level would have been nearly 30 percent more than it actually is. The debate on reform of the U.S. health care system offers both mandate and opportunity to redress the erosion that has occurred in the public health infrastructure by establishing a secure and adequate funding base for the core functions of public health at every level.

Critical to resolving the problem of health disparities among Latinos is examining the needs within ethnic subpopulations. This paper focused on the unique challenges encountered by one ethnic subpopulation -- Latinos of Mexican descent living in colonias. Findings reaffirm the importance of looking within ethnic subpopulations to understand the complexities of health disparities. This paper reports on data collected measuring access to health care among Latinos of Mexican descent living in several colonias in two southern Texas counties. Observations are based on data gathered from a nonprobability sample obtained through a face to face questionnaire focusing on health care access. Persons living in two Texas counties near the US border were included in this sample, and demographic data were compared to county, state and national statistics to examine the comparability of the sample to similar populations. Findings from this snowball sample, N=271, suggested lower rates of health insurance coverage compared to the Latino population nationwide, decreased patterns of preventive screenings for blood pressure, diabetes, cholesterol, cancers (ie, breast, cervical, and prostate), and regular access to health care in Mexico by slightly more than half the sample. Seeking care in Mexico may be a viable solution for many indigent people of Mexican descent living in close geographic proximity to the border because it surmounts the political, cultural, linguistic, or economic barriers to health care services in the United States. Nonetheless, there are longer term questions regarding quality of care and health and wellness for this group of people.

This paper investigates the effects of health insurance enrollment on health disparities among different racial groups in the United States. Two models were constructed and estimated empirically where a health insurance disparity model was nested in the health disparity model. The Blinder-Oaxaca decomposition method was used to measure potential racial discrimination in health status. The racial gap in health disparities was broken down by endowment and treatment effects. The results show that the health status gap can be explained by potential discrimination in health insurance enrollment between Blacks and Whites. Overall, health insurance enrollment plays a critical role in explaining racial disparities and a racial disparity in the healthcare industry explains a nontrivial portion of the differences in health status. [ABSTRACT FROM AUTHOR]

This paper presents a dynamic general equilibrium model designed to examine the macroeconomic effects and welfare implications of alternative reforms to the US health insurance system. Specifically, it scrutinizes the extent to which health care reform can mitigate inefficiencies stemming from market imperfections in the health insurance industry. The model considers a stochastic overlapping generations framework, incorporating heterogeneous agents who are subject to uncertain health shocks. These individuals make optimal decisions regarding labor supply, health insurance, and medical services. Given that the optimal levels of medical consumption and hours worked are endogenous, this setting encapsulates general equilibrium effects. The model is calibrated to US data, and numerical simulations suggest that suitable adjustments to the present health insurance system can broaden coverage and enhance welfare. This improvement is achieved by reducing adverse selection, improving overall health status, and lessening tax distortions on labor supply. [ABSTRACT FROM AUTHOR]

Aims: To identify the barriers and facilitators to healthcare for people without documentation status. Design: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Methods: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social‐ecological model. Data Sources: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. Results: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti‐immigrant rhetoric) and policy‐related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety‐net clinics and supportive federal policies emerged as key facilitators. Conclusion: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. Impact: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. Reporting Method: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Patient or Public Contribution: No patient or public contribution was needed. Trial and Protocol Registration: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289). [ABSTRACT FROM AUTHOR]

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence. [ABSTRACT FROM AUTHOR]

There are at least two sources of health insurance coverage estimates in the United States: the Behavioral Risk Factor Surveillance System (BRFSS) and the Small Area Health Insurance Estimates (SAHIE) program. This paper addresses the integration of BRFSS and SAHIE data using multilevel models that account for the different levels of aggregation at which data are available and for the different errors to which data are subject to. The uncertainty in the initial state-level estimates available from BRFSS and SAHIE is improved by borrowing information from both sources and across geographies. County-level model estimates are produced on both BRFSS and SAHIE scales, improving the usability of the BRFSS public-use data and inspiring possible extensions to estimation of BRFSS quantities other than health insurance coverage. The application uses 2018 public-use data. Parallels to small area estimation models and measurement error models are briefly discussed. [ABSTRACT FROM AUTHOR]

Abstract Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments. [ABSTRACT FROM AUTHOR]

The article offers the author's comment on the article "The Early Impact of the Affordable Care Act, State by State" by Amanda E. Kowalski. The author says that the paper provides an important preview about the impact of the U.S. Affordable Care Act (ACA) on insurance coverage in the individual market. An overview of the paper, which is based on data from the National Association of Insurance Commissioners (NAIC), is also provided.

Scientists, public servants, and patient advocates alike increasingly question the validity of published scientific results, endangering the public’s acceptance of science. Here, I argue that emerging flaws in the integrity of the peer review system are largely responsible. Distortions in peer review are driven by economic forces and enabled by a lack of accountability of journals, editors, and authors. One approach to restoring trust in the validity of published results may be to establish basic rules that render peer review more transparent, such as publishing the reviews (a practice already embraced by some journals) and monitoring not only the track records of authors but also of editors and journals. [ABSTRACT FROM AUTHOR]

In this paper, we develop a life cycle model that features pecuniary and non-pecuniary investments in health in order to rationalize the socioeconomic gradients in health and life expectancy in the United States. Agents accumulate health capital, which affects labor productivity, utility, the distribution of medical spending shocks, and life expectancy. We find that unequal health insurance coverage plays a negligible role in generating the observed gaps in health and longevity. Universal health insurance increases preventive medical spending but not time spent in health promoting activities, as individuals are no longer worried about avoiding high curative medical expenditure shocks due to increased health insurance coverage. Our findings suggest that differences in lifetime income, preferences, and health shocks are the main determinants of inequality in life expectancy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a systematic review of empirical evidence on the labour market effects of health insurance from the supply side. Design/methodology/approach: The study covers the largest peer-reviewed and working paper databases for labour economics and health studies. These include Web of Science, Google Scholar, Pubmed and the most popular economics working paper sources such as NBER, ECONSTOR, IDEAS, IZA, SSRN, World Bank Working Paper Series. The authors follow the PRISMA 2009 protocol for systematic reviews. Findings: The collection includes 63 studies. The outcomes of interest are the number of hours worked, the probability of employment, self-employment and the level of economic formalisation. The authors find that the current literature is vastly concentrated on the USA. Spousal coverage in the USA is associated with reduced labour supply of secondary earners. The effect of Medicaid in the USA on the labour supply of its recipients is ambiguous. The employment-coverage link is an important determinant of the labour supply of people with health problems and self-employment decisions. Universal coverage may create either an incentive or a disincentive to work depending on the design of the system. Finally, evidence on the relationship between health insurance and the level of economic formalisation in developing countries is fragmented and limited. Practical implications: This study reviews the existing literature on the labour market effects of health insurance from the supply side. The authors find a large knowledge gap in emerging economies where health coverage is expanding. The authors also highlight important literature gaps that need to be filled in different themes of the topic. Originality/value: This is the first systematic review on the topic which is becoming increasingly relevant for policy makers in developing countries where health coverage is expanding. [ABSTRACT FROM AUTHOR]

This paper identifies the effect of the Affordable Care Act's dependent coverage mandate on health insurance coverage and labor market outcomes among young adults by exploiting the discrete change in health insurance coverage at age 26. Using a regression discontinuity design, we find that aging out from the ACA's dependent coverage mandate is associated with up to a 4.2-percentage-point decrease in private insurance coverage at age 26. We also find that aging out from the mandate is significantly associated with an increase in the probability of being employed. However, we do not find any significant changes in hourly wage, weekly working hours or job mobility at age 26. [ABSTRACT FROM AUTHOR]

As a country, the United States spends significantly more on healthcare than other advanced industrialized countries, and Americans have comparably worse health outcomes. Both are developments of the last four decades. In this paper, we look at how change in antitrust and patent law and thus change in market power in the largest four subsectors of healthcare, hospitals, physician groups, prescription drugs, and net medical insurance, have contributed to the increasing cost of medical care in the United States. We show that the annual rent – the degree to which health care is overpriced as a result of market power – was between 2.47 and 4.30 percent of GDP in 2016 – truly a big cost for big medicine. [ABSTRACT FROM AUTHOR]

Objective: Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country. Methods: We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972–2000" and 2015–2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties. Results: Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country. Discussion/Implications: Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging. [ABSTRACT FROM AUTHOR]

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers. [ABSTRACT FROM AUTHOR]

This paper uses data from the Medical Expenditures Panel Survey, a U.S. health care survey, to simulate the impact of reinsurance on insured health care expenditures for different cohorts. The paper concludes that reinsurance would not eliminate potential risk selection by insurers and, even with reinsurance, specific cohorts would have trouble obtaining affordable insurance unless reinsurance was accompanied by significant changes to U.S. insurance laws including the adoption of guarantee issue requirements and the abolition of underwriting based on health status or pre-existing conditions. The simulation model reveals that the impact of reinsurance on insurance expenditures is larger for older cohorts than for younger cohorts. [ABSTRACT FROM AUTHOR]

The article presents several news related to various universities in the U.S. Indiana University of Pennsylvania has acquired the United Mine Workers of America District 2 Collection. The collection consists of almost 400 boxes and includes papers associated with the presidencies of John Brophy and James Mark and executive files including presidential correspondence, injunctions and other documents. The Knight Library at the University of Oregon has opened the Records of the International Woodworkers of America to researchers. The records, which span from 1936 to 1987 and till nearly 600 linear feet, consist primarily of correspondence, minutes, proceedings, negotiation files, expired contracts, legal and financial documents and officer and departmental records. In addition to the union's basic activities, such as organizing, negotiations, litigation, and strikes, the collection documents the conflict between the red bloc and white bloc forces in the union during the 1940s and 1950s. Papers from the presidency of Keith Johnson deal with Canadian softwood lumber imports, national health insurance, labor law reform, affirmative action, occupational safety and health and other issues.

The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods. [ABSTRACT FROM AUTHOR]

The decoupling of child Medicaid from the cash welfare system greatly increased access to public health insurance for low‐income children in the United States. In this paper, I show that the federally mandated public health insurance expansions of the late‐1980s and early‐1990s significantly increased the number of public high school completers in the 2000s. Using the legislated generosity of a state's child Medicaid program as a time‐varying, exogenous source of variation in a quasi‐experimental design, I find substantively large declines in the dropout rate and, importantly, large increases in traditional 4‐year graduation rates. Results for both measures are driven by Hispanic and White students, the two groups experiencing the greatest within‐group increases in eligibility due to the decoupling of child Medicaid from the Aid to Families with Dependent Children program. In addition, I find evidence that increases in the length of childhood years covered (e.g., through age 5 vs. through age 17) leads to greater gains in completion rates. This suggests that public health insurance coverage throughout childhood produces the largest effect. [ABSTRACT FROM AUTHOR]

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]

This paper investigates Medicare supplemental insurance and health-care spending. The empirical models attempt to determine whether seniors who possess certain traits, particularly health- and risk-related factors, choose supplemental coverage based on expectations of health-care needs. Employer-provided supplemental coverage is considered separately from official 'Medigap' policies. Results indicate favorable selection into supplemental insurance based on health status, but no selection based on risk attitudes. The models indicate that Medigap and employer-provided enrollees spend approximately $1,000 and $1,500 more annually, respectively, than those without supplemental coverage. Finally, moral hazard induced by Medicare supplemental coverage appears to add $5.5 billion annually to the federal budget, although this estimate lacks statistical significance. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of the Affordable Care Act's Medicaid expansion on the retirement decision of low-educated adults aged 55-64. I employ a difference-in-differences strategy that exploits the timing and expansion decisions of states for adults without dependent children. I find that the expansions increase Medicaid enrollment for both men and women. The estimates also suggest that the expansions result in women retiring early, whereas there is no significant change in the retirement behavior of men. These findings imply that the effect of health insurance on women's retirement decisions may depend on men's labor market responses to health insurance. [ABSTRACT FROM AUTHOR]